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Outcome of non surgical root canal treatment at muhimbili national hospital, tanzania


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Root canal treatment is aiming at retaing teeth with irreversible pulp damage as functional and pain free

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Outcome of non surgical root canal treatment at muhimbili national hospital, tanzania

  1. 1. OUTCOME OF NS-RCT, MUHIMBILI NATIONAL HOSPITAL, TANZANIA Rukoma A.M; DDS, Mdent. (Restorative) Kano Dental Clinic
  3. 3. Definition <ul><li>Non-surgical root Canal Therapy (NS-RCT) : </li></ul><ul><li>removal of tooth pulp </li></ul><ul><li> replacement with a biocompatible artificial. </li></ul><ul><li>no raising of flap </li></ul>
  4. 4. Indications <ul><li>Irreversible pulpitis </li></ul><ul><li>Irreparable pulp exposure </li></ul><ul><li>Pulp necrosis +- AP (Tronstad, 1991) </li></ul><ul><li>Some orthodontic treatment </li></ul><ul><li>Intentionally in crown or bridge (Grossman , 1978 ). </li></ul>
  5. 5. Goal <ul><li>Prevention and/or elimination of pathology of endodontic origin in the root canal and periapical areas. </li></ul>
  6. 6. Importance <ul><li>Retain the affected tooth and its functions, namely:- </li></ul><ul><ul><li>Mastication </li></ul></ul><ul><ul><li>Speech </li></ul></ul><ul><ul><li>aesthetics </li></ul></ul>
  7. 7. Treatment outcome <ul><li>Depends on:- </li></ul><ul><ul><li>correct diagnosis </li></ul></ul><ul><ul><li>proper debridement </li></ul></ul><ul><ul><li>And adequate obturation. </li></ul></ul><ul><li>(Bystrom et al., 1985; De Moor et al., 1999; Dovgan, 2004b). </li></ul>
  8. 8. <ul><li>Radiography is the most reliable tool in determination of treatment outcome </li></ul><ul><li>at least 3 PA radiographs are needed. </li></ul><ul><li>1 st radiograph </li></ul><ul><ul><li>Confirm diagnosis </li></ul></ul><ul><ul><li>Assess the status of canal(s) </li></ul></ul><ul><ul><li>Assess the status of periapical area </li></ul></ul><ul><ul><li>Assist estimation of working length </li></ul></ul>
  9. 9. <ul><li>2 nd radiograph </li></ul><ul><ul><li>Determination of working length </li></ul></ul><ul><li>3 rd radiograph </li></ul><ul><ul><li>Assess quality of canal obturation and/or coronal restorations (Kustarci et al., 2007). </li></ul></ul>
  10. 10. <ul><li>The treatment outcome of NS-RCT is assessed basing on </li></ul><ul><ul><li>Type of treated teeth </li></ul></ul><ul><ul><li>technical quality of obturation </li></ul></ul><ul><ul><li>patient signs and symptoms (pain, swelling and sinus) </li></ul></ul><ul><ul><li>tooth function (mastication, aesthetics & speech) </li></ul></ul>
  11. 11. Types of teeth treated <ul><li>The most commonly reported teeth treated are: </li></ul><ul><ul><ul><li>Molars - (Kirkevang et al. 2001; Bjørndal, 2006) </li></ul></ul></ul><ul><ul><ul><li>Premolars - (Oderinu, Shaba and Adegbulugbe, 2006) </li></ul></ul></ul><ul><ul><ul><li>Anteriors - (Iqba et al. 2005) </li></ul></ul></ul><ul><ul><ul><li>Evenly distributed - (Michael, 2003) </li></ul></ul></ul><ul><li>NB: most studies show more root filled teeth in the maxilla than in the mandible - (Peak et al. 2001; Ajayi and Ajayi 2007; Gulsahi et al. 2008) </li></ul>
  12. 12. Obturation quality <ul><li>Inferior technical quality of root fillings (inadequate) is considered to be the main cause of clinical failure. Eckerbom et al., (1989). </li></ul><ul><ul><li>It leaves residual space for microbial colonization and proliferation . </li></ul></ul><ul><li>The tooth is adequately obturated when: </li></ul><ul><ul><li>no lateral voids/lumens </li></ul></ul><ul><ul><li>apical lumen does not exceed 2mm from the apex </li></ul></ul><ul><ul><li>GP does not pass through into periapical areas </li></ul></ul>
  13. 13. Patients’ satisfaction <ul><li>Patient satisfaction is a personal evaluation or appraisal of a service or product received (Aharony and Strasser, 1993; Pascoe, 1983). </li></ul><ul><li>It is a key factor in quality assessment of the health care system (Gold and Woodridge, 1995). </li></ul>
  14. 14. <ul><li>Determining the outcome of NS-RCT can serves as an indicator of service quality and so assist in improvement of the treatment provided through proper planning </li></ul>
  15. 15. 2. AIM <ul><li>To investigate the outcome of NS-RCT provided at the Muhimbili National Hospital using defined clinical and radiographic criteria so as to obtain baseline data </li></ul>
  17. 17. <ul><li>A cross section prospective study was conducted at the dental clinics of MNH from June-July, 2008 </li></ul><ul><li>A total of 120 patients aged 15+ years who received NS-RCT on a single tooth of main complain were studied </li></ul>
  18. 18. Data collection <ul><li>A questionnaire was used to gather information on patients socio-demoraphic characteristics and patients satisfaction </li></ul><ul><li>Clinical data was sought from clinical cards and post obturation peri apical radiographs </li></ul><ul><li>The radiographs were reviewed to assess the obturation quality (apical and lateral seal) </li></ul>
  19. 19. <ul><li>The tooth types were recorded according to FDI Tooth Notation for Permanent Teeth and recorded in designed form. </li></ul><ul><li>The tooth types were later decoded as anterior teeth, premolars and molars and in relation to jaw type. </li></ul>
  20. 20. <ul><li>Seal adequacy </li></ul><ul><li>Apical seal - if the GP was within 2mm from the radiographic apical constriction </li></ul><ul><li>Lateral seal - if there was no lateral void/lumen between GP and canal walls </li></ul><ul><li>Overall - only if both lateral and apical seals were adequate. (Sidaravicius et al. 1999) </li></ul>
  21. 21. <ul><li>Patients satisfaction with the provided NS-RCT was assess by using a five-point Likert scale (1=very satisfied to 5=very unsatisfied) </li></ul><ul><li>Overall satisfaction with the provided NS-RCT was assessed from masticatory function and appearance of the treated teeth </li></ul>
  22. 22. Data management and analysis <ul><li>The collected data was recorded on paper and then encoded and transferred to computer and analyzed using Epi info 6 version 6.04 </li></ul><ul><li>The level of significance was set at p-value ≤0.05. </li></ul>
  23. 23. 4. RESULTS
  24. 24. Fig.1 Percentage of teeth type treated (n=120)
  25. 25. Table 1 : Distribution tooth type adequately obturated (%) Adequate Tooth type Total anteriors Premolars molars Apical seal 34(70.8) 31(88.6) 17(46.0) 82 (68.3) lateral seal 45(93.7) 30(85.7) 15(40.5) 90 (75) Overall 34(70.8) 29(82.9) 15(40.5) 78 (65.0)
  26. 26. Table 2: Distribution of patients satisfaction by sex (%) Satisfaction Sex Total Male Female Mastication satisfied 43 (95.6) 74 (98.7) 117(97.5) dissatisfied 2 (4.4) 1 (1.3) 3(2.5) Appearance satisfied 43 (95.6) 66 (88.0) 109(90.8) dissatisfied 2 (4.4) 9 (12.0) 11(9.2)
  27. 27. 5. DISCUSSION
  28. 28. <ul><li>It is important to emphasize that the population in this survey may not be representative of those patients receiving NS-RCT in Tanzania as a whole. </li></ul><ul><li>Further, the radiographs used in the study may not had been taken in standardized manner; the inevitable changes in beam / film angulations </li></ul><ul><li>Despite this shortcoming the information is both interesting and Valuable. </li></ul>
  29. 29. <ul><li>The observation that upper anterior teeth were treated more than other teeth is in agreement with Iqba et al. (2005) </li></ul><ul><li>Due to their location, they are the most visible and easily accessible. </li></ul><ul><ul><li>For aesthetic reasons, if these teeth become discoloured or carious the patient may easily demand or accept treatment. </li></ul></ul><ul><ul><li>Practitioners preference – they are easy to maneuver </li></ul></ul>
  30. 30. <ul><li>The observed obturation quality is comparable to studies done in developing and developed countries. </li></ul><ul><ul><li>Peak et al. (2001) in the UK </li></ul></ul><ul><ul><li>Boltacs-Rzepkowska and Pawlicka (2003)in Poland </li></ul></ul><ul><ul><li>Barrieshi-Nusair (2004) in Jordan </li></ul></ul><ul><ul><li>Rafeek et al. (2009) in Trinidad and Tobago </li></ul></ul>
  31. 31. <ul><li>The observation that, premolars and anterior teeth were the most adequately obturated is attributed to their anterior location, canal number and morphology. </li></ul><ul><li>Single or two root canal(s) which are relatively wide and straight when coupled with anterior location make them easily accessible for instrumentation </li></ul><ul><li>Molars are located far posterior with three or more relatively small canals which are sometimes curved </li></ul>
  32. 32. <ul><li>The rate of patients’ satisfaction with the provided NS-RCT of 96.6% is similar to findings reported by Salehrabi and Rotstein, US (2004)- 97%; G õrduvsus and G õrduvsus, Turkey (2000)- 82%. </li></ul><ul><li>This implies that root canal therapy meets most patients’ expectations of freedom from pain and regaining masticatory and esthetic needs. </li></ul>
  33. 33. Conclusions <ul><li>Majority of teeth treated with NS-RCT were maxillary anterior teeth. </li></ul><ul><li>Molar teeth were poorly obturated </li></ul><ul><li>The level of satisfaction with the provided treatment was high </li></ul>
  34. 34. Recommendations <ul><li>Community education on the importance of conserving all teeth </li></ul><ul><li>Improvement in treatment of molar teeth </li></ul><ul><li>More and long term researches on RCT are need. </li></ul>
  35. 35. <ul><li> * * * * * * * * * * </li></ul>Thank you * * * * * * * * * *